A leaked report has prompted a drastic operational review of the Shellharbour Hospital’s Eloura West mental health unit.

The investigation revealed there was no defined “model of care” which was a contributing factor in an alleged murder of one patient by another in July.

The report highlighted existing confusion among mental health staff as to whether the ward fulfilled a high dependency role or an acute observation unit.

This week NSW Health Chief Psychiatrist Dr Murray Wright visited the hospital in the first step in helping establish a clear model of care but stressed there was no state-wide “fixed definition” for such units.

“The title of the unit can vary from site to site and district to district,” he said.

“There are many units which don’t have a published model of care because there is a high level of understanding of what that unit does through various other polices and documents,” he said.

Dr Wright said NSW Health recognised three levels of mental health care - acute, sub-acute and non-acute care and the definition of the facilities were in the hands of local health districts (LHD).

NSW Nurse and Midwives Association general secretary Brett Holmes said the problems that could arise from informally defined unit roles had been “bubbling” away for some time.

“Unless the unit sits into an intensive mental health care model, then it’s a local decision on what they call them,” Mr Holmes said.

“So we have this crazy situation where clearly there’re patients that need close observation and high dependency units, but the mental health drug and alcohol directors at the ministry of health won’t fund such units.

“It leaves LHD’s having to fund these services out of their standard funding models, which are inadequate and puts both patients and staff at risk.”

Mr Holmes said informally defined high level care units had “sprung up” in LHD’s in response to patients who showed behaviours that were too unpredictable for general mental health wards and didn’t meet the criteria for intensive care units.

Mr Holmes said there were 62 intensive care mental health beds in NSW, six in metropolitan areas and two in regional areas.

“This is a small amount given the increasing level of violence inducing drugs, particularly ice, that have to be contained outside of those intensive care units,” he said. “It puts significant strain on staff, emergency departments and other units.”

“Clearly there needs to be better recognition from the ministry of health and better funding for this level of care that doesn’t sit into their definition of mental intensive care.”

A spokesperson for the Minister for Mental Health said NSW health provided funding for three levels of inpatient activity – mental health intensive care, acute and non-acute.

“Specific role delineation of services is part of the process of service planning and development that balances state-wide and local mental health priorities,” he said.

“Planning for intensive mental health care beds has been based on the current and projected population need.

“All patients receive care according to their individual level of need. This may mean patients deemed at higher risk receive a higher level of observation and care within the acute inpatient unit, such as being nursed close to the nurses’ station or being nursed on a one to one basis.”